Previously dedicated as a journal for my book project, the Round Table is an area where I'll be sharing lessons learned, take away messages, and engaging ideas during my MPH program at Johns Hopkins Bloomberg School of Public Health. As always, the goal is to inform, challenge, and inspire. Use the side archive to find select titles.

Monday, January 28, 2008

I sit behind her and can only think that I have traveled into the world of a Shakespearean tragedy. The rollercoaster ride has death, love, suffering, and now prayer. The words begin to come out of her mouth. She speaks aloud to the dead body and then folds her hands to her head to signal she is praying. A calmness sets in, but an uneasiness enters. A chill runs over me as I stare and try to imagine myself in her shoes.

It was the start of my second day and already I knew my back and hands could not take another full day of giving massages. I remembered seeing wheelchairs the day before near the bathroom and thought I could shuffle in wheelchair rides to give my body a slight break. However the physical strain was only transferred to my mind and emotions.

It started simply and in the middle became quite challenging. A nurse brought me to someone she thought would want to go outside and informed me that the patient had "a slow brain". The woman barely spoke a word to me the day before and her facial expressions did seem a little abnormal. I helped the woman into the wheelchair and started to go outside. Something was obviously up as she pointed to the left. A female french photographer greets me outside and asks if I was going to take her for her daily tour. She took my puzzled look as a sign to explain further. She continued by telling me that a Maryknoll priest had been volunteering at the Temple for almost six years and had taken the woman out every morning to pray and see her boyfriend. However, the priest has since been stationed inTanzania and the morning ritual has gone away with him. From what I have been told no one else had taken interest in continuing the ritual.

We begin by stopping at a small shop and she asks for a energy drink with two raw eggs in it. The photographer ques me in on the story and outlines the "stops" before going off to finish her work with TIME magazine. The woman came to the Temple over eight years ago with her husband. They both had HIV and the husband soon passed away. Over the years she fell deeply in love with another HIV positive man at the Temple. He passed away as well and in an act of despair she attempted suicide by jumping off a roof. She broke her hips, damaged her mouth, and did some nerve damage as well, which explains the "slow brain" and her inability to walk or stand. When I heard this story I could not help but think it was a plot from a depressing and twisted movie; one that depicted a rollercoaster of emotions and in the end left the main character bedridden and alone.I am told that she shared a deep and affectionate relationship with the man she met at the temple and soon they became "the couple" all could see constantly together.

By this time we had already stopped at the Buddha shrine and she has prayed using the traditional three sticks of incense (see photos on sidebar). We make our way to the infamous Life Museum and I hesitate to enter. The photographer sees my hesitation and points to one man on display and says . . . that is him! She leaves as quickly as she came and I am torn on what to do. Does she really want to be rolled into a room full of dead bodies who succumbed to death from the same virus she has? Does she really want to be locked into a seat a few yards from the naked and partially decayed body of a man who she passionately loved and attempted suicide over? Even if it were torturous, how would I know what she is saying or trying to communicate? The questions flooded my mind as I lifted the chair over the step and then finish locking the wheelchair in its place.

She has not been here in almost a month and all I can do is think about what she is saying out loud. After ten minutes she claps three times and rubs her head - it's the signal that she is done. She opens up as we leave the life museum. She laughs and starts to talk as we make our way to the stand at the front gate. Once there I buy her some of the plastic bracelets that she loves to wear. During this time she gets to talk to some of the vendors, who are HIV positive as well. It's her only time to socialize because in the infirmary attention is not something she is accustomed to. I bring her back and realize after 40 minutes and 2 dollars that what started as a way to take a break ended up making someone's day in way I would never have expected or anticipated. Now when I first walk in she looks at me and signals to the door with a smile. Sadly every time I bring her back I can not help but wonder if after I leave she will be resigned to the bed and never get a chance to go for what some might think is just a wheel chair ride.

Friday, January 25, 2008

A Stunning Example of How East and West Differ (Photos included in Sidebar Slide show)

If controversy arose from the Bodies Exhibit that opened in major US cities, then I can not imagine what response the Temple's Life Museum would garner. The differences between East and West are ever present when one enters the museum. Whereas the Bodies Exhibit was heralded as a new scientific approach at illustrating what I would say is the miracle of life, the Life Museum makes no such attempt or approach. It is quite simply twelve former patients, ranging from old to infant and sex worker to buddhist monk, who have a few things in common; they are Thais, they died because of HIV, they are completely naked, and they have been dead for years with all the signs of death you would imagine.

It is obvious that as a westerner one views the exhibit in a state of shock. The sheer morbidity and the deceased naked bodies remind you of just how fragile life is and what eventually awaits us all. The bodies are held up by metal clasps and no display case or boundary separates the viewer from the body being viewed. Next to their petrified bodies is a sheet that states the name, occupation, date of birth and death, and how contracted HIV. A knot turns in my stomach as I approach the three infants of the exhibit. You do not want to look or imagine what this child's parents or gaudarians went through six years ago when she passed away.

The volunteer coordinator explains to me that she knows the museum is very controversal to westerners. I have already noticed some that walk out quickly with a face that shows exactly what they are thinking. Yet, many thais and asian visitors stand in the museum snapping photos and bring children of all ages all for the ride. Why such a discrepancy? The sign that rests in the corner of the room attempts to tackle the reasoning.

Personally, I see the entire exhibit as a challenge to try to wipe the slate clear and just absorb and observe with a fresh and non-judgemental mind. It is extremely difficult but it must be done. What you learn is that one tradition is not "better" or more "right" than the other. They simply are different and approach fundamental issues through differing lens.

I will end this post with the aforementioned sign because the Buddhist monks have captured the essence of the story better than I can. The sign reads . . .

"The Spirit of those who have died here teach us how to think about our life today and in the future. We understand that life is all around us. But sometimes we forget that we are connected to all of life. Death is a part of life and we forget to accept this truth. Death leads to the birth of new life. We invite all of you who come to this place to be silent as you experience what you see here. This museum has many bodies that shows how death affects all of us. Leading us to the truth that in life we must do good for others."

Tuesday, January 22, 2008

I shake his hand and tell him that I did not understand a word from his mouth; but it was obvious he was speaking sincerely and from the heart. Weeks of emails and phone calls had gotten me and my Thai host no where as many attempts to contact him always failed. Even though I had never seen him, it was like I already knew him. His photo, either alone or with patients, is all over the temple including over some patients' beds. We had just spent nearly two hours with him, which I knew was something unique and special.

I was already in my fourth day of volunteering at the Temple and I wanted to introduce myself. Word comes back that I can see the Abbott Sunday at 3pm. I rush to call my interpreter because I am told that my interview should be done at this time. Flash to 2:55pm and we are waiting outside his small building. Accompanying us are over 25 pairs of shoes. I learn Sunday is the day villagers come, make donations, and then get to see the Abbott. While we wait I get versed in the proper way to address the Abbott and reminded of both how important he is and the respect that all must show him.

The door slides open at 3:15pm and we are invited in. The room is furnished with golden Buddhist statues and other elaborate decorations (see photos). I quickly tell my interpreter, Aoh, there is no way I can interview him in front of all these people. Before I know it I am told it's our turn. Aoh asks if I know the proper greeting. I stare at him with confusion and realize all around are on their knees bowing. I quickly get down but do not touch my head to the ground as the others. The Abbott is sitting peacefully in his burnt orange robes, the signal of meditation monks. It is time to think quickly. I slide in front of the monk, graciously bow my head, and begin to introduce myself in a very slow and clear voice. I feel as though I am in an Indiana Jones movie -

"SahWah Dee KhrupLauwpawAlongkot, my name is Marco Ambrosio and I have come from America to include your Temple's story of compassion in a book I am writing". I know I only have a few other moments so I inform him of all my contacts that suggested I come to his temple and let him know I have been volunteering at the infirmary. He smiles kindly and welcomes me.

A huge sigh of relief rushes over me as a slip up or negative response from the Abbott would have ended my time at the Temple and weeks of planning and funds. All my excitement is crushed as I see Aoh talking in Thai and looking quite frazzled. He comes back to tell me that they will give me 15 minutes alone for an interview. I know and Aoh knows that the interview takes at least an hour and fifteen minutes. I simply decline. We reiterate that I have come from America with this specific goal and need enough time for the interview. The response . . . the Abbott will be free after his speech at the site of Project II.

Great! Right? Wrong! I find out the site is over an hour away and we have no way there or back! I am told that it will be my only chance to interview him as his schedule is full for the week. Aoh works some magic and befriends a crew from National Geographic. They are in the same boat but they have a life raft - a car. The entire time I am in shock that a scheduled appointment that was confirmed would end up this way, but then I recall a famous Buddhist saying "Mai Pen Rai" (Don't Worry/No Rush). Three hours later I found myself sitting next to Dr. Alongkot the person. No kneeling or intimidating shrines or followers bowing all around. Instead when we rise for photos he is swarmed by over ten different children who live at the facility with HIV and a group of dogs that call the site home as well. In the end, "Mai Pen Rai" was right.

Sunday, January 20, 2008

Difficulty in communicating was something I anticipated when conducting this project abroad. However, the degree is amplified when you spend the majority of your day in an AIDS hospice infirmary. "How do you feel?" and "Is there anything I can do to help?" are things I can only wish to say to the person lying in the bed. Instead it is a smile and a bow. When I do try to speak, the best Thai that comes out is hello, my name is Ma-Ko (the R sound is difficult for Thais) and I am a writer from America. Honestly, who cares about any of that. I had to think of other ways to say I am here or you are not alone because these options were just not enough.

Then the massages started. I signed on to do "physical therapy", which is really nothing more than a gentle massage with an Icy-Hot style cream. I was certainly nervous to say the least, and the sweat that accumulated in my gloves was an easy indicator. Me, nervous? A person that knows the way HIV spreads! I was almost ashamed at myself. After the first person the trepidation subsides and the pure observations begin. The majority of the patients are covered in small scares - old lesions and new, the legs and arms are spotted like a leopard. I soon realize that I am in for quite the day as every time I finish there is a new person that wants a massage. It must be for the attention or the touch of someone besides to take their blood pressure or change their diaper. Surely I am not the world's best masseur, especially in a country renowned for its massages.

I have been told that the hospital ward is a mixture of very seriously ill patients but also moderate and mild cases as well. They are not separated but it is usually pretty obvious by their weight and skin. Some are skin and bones. You massage expecting to feel a muscle and yet your fingertips are greeted by flappy wrinkly skin and a hard bone. The skin is very dry and pieces of hair fall out during the massage. I would think that I was hurting or boring them if it were not for the smile or some indication that they want me to continue. However, when tour groups come into the hospital, about three do a day, you feel utterly connected to the person. The pictures and videos are taken and you try to ignore them by continuing with the "physical therapy", but usually I am overwhelmed by putting myself in the patient's shoes. Some talk to the visitors, many of which bring small gifts or cash handouts, and others simply stare off or do not pay any attention. They never turn down a photo, but then again many are never given the chance. When not asked I try to squeeze a little harder or rush to a new spot attempting my best to grab the patient's attention because no one wants to be treated like a side show or exhibit.

A massage is certainly not an answer to any of these people's problems, and I know that there is very limited, if any at all, medical benefit coming from massaging legs and feet. I can not hold a conversation to talk about things that interest them or even get to know them. They remain a person, a fellow person and I can try my best to show they are not alone. I finish a massage and, like always, their hands go up in a praying manner to their forehead and they say thank you. So many words build up inside me waiting to flow out but the only thing I can say is "Thank you" with a smile and a bow.

Saturday, January 19, 2008

Then and Now of AIDS TempleNestled in the foothill of mountains roughly 5 km from a main avenue, you can find a Buddhist Temple that brings the word compassion to life. Although the temple sits 120km north of Bangkok, in its confines all of Thailand is represented. Its reputation holds true to this statement, as the majority of Thais that learn of my project have made sure I know of its existence and location.

In 1992, the temple turned into a small 8 bed AIDS hospice after Buddhist monk Dr. AlongkotDikkapanyo witnessed the death of an AIDS patient at a nearby hospital. The initial people that entered the temple were in the late stages of AIDS and had been abandoned by all they knew. Dr. Alongkot's goal was simple - provide solidarity through compassion and let the people pass with dignity. A simple goal was met with more than emotional costs.

It is tradition for buddhist monks to go into the streets with an empty bowl. In this bowl people put money or food that is then pooled together at the Temple to feed the monks. The people gain merits for their prayers, loved ones, and ancestors and in return the monks are provided with sustainance. Townspeople lacked any information about HIV and feared the idea of having an AIDS hospice set up in their area. Would the large corn fields that separate the temple from houses get the disease? Could we get the disease by getting close to Dr. Alongkot? As a result, no one put food in his bowl! The fear and task would normally appear daunting.

Through the hard work of the monks, none more than Dr. Alongkot, the temple has grown to 400 beds, 3 separate projects, and a source of pride for the town and Thais from around the country. Some even say that it is the best HIV/AIDS organization in the country and I am sure everyone will ask (just like I did), "What makes it so?". In two days I have learned the answer. For starters, the AIDS temple does treatment and prevention to the best of its ability while receiving the majority of its funds from private donations. It receives around $3000 from the government annually and yet has found a way to build quite a facility. The infirmary holds 33 beds, which includes an adjacent 6 bed TB wing, separate housing for HIV positive males and females, family style housing for couples, advocacy museums that see class trips and families as visitors, and a newly constructed orphans village located quite a distance from temple grounds. Now flash to Saturday January 19, 2008 and you will see people throughout the day coming in to drop off donations that range from rice, rubbing alcohol, and stuffed animals.

Wednesday, January 16, 2008

I will be spending the next 10-12 days at the AIDS Temple with the goal of incorporating their work into the project. Their story is quite unique and moving to say the least. The Temple began as a place to gain a dignified passing as a buddhist monk began taking care of people in the late stages of AIDS who had been abandoned by much of society, family and friends included. His goal has always been to bring compassion back into the lives of those who, in essence, need so much.

The temple has grown immensely since it's start in 1992. It has developed three separate projects, including housing for families affected by HIV. I hope you visit their website to learn more about their work (http://www.aidstemple.th.org/). This entry will win the contest for shortest, but I assure you it is because the three hour bus ride north to the temple is preceded by an unanticipated hour trip to the bus terminal.

I am not sure if Lopburi will have internet access but assure you that upon arrival there will be much to read. (edit update: I have found an internet cafe within walking distance from the hotel I am staying at in Lopburi)

Saturday, January 12, 2008

If you went up to the majority of my friends from the United States and said “Long Live the King” they would probably think you are studying a Shakespearean tragedy or getting into an Elvis groove. However here in Thailand everywhere one goes the King is ever present and they would not have it any other way.

Simply put I have found in my days here in Thailand that Thais love two things – food and the King. What do I mean? Well for instance, when the 80 year old King was not feeling well last year, the people organized a campaign to wear yellow on Mondays. Over a year later it is still in full effect as more than half the city of 12 million people wears yellow. It has become a staple to show unity and respect for their beloved head of state. The idea is very Buddhist in nature. The belief is centered on how the thoughts and goodwill send positive energy to the King. It does not stop with wearing the King’s color on Mondays. His flag is flown next to where ever the Thai flag hangs and large tributes and posters of him in various stages of life line the main avenues and various buildings (See photos).

In the States, the idea of a king in the 21st century would probably be greeted by a New York catch phrase, but when you dig deeper it makes sense in this country. The King is seen as a humanitarian, an honest man, and someone who always has the best intentions for the people of Thailand. This belief is unquestioned and uniform throughout all of Bangkok. The Buddhist temples praise him for his demeanor and spirituality. The older generations revere him and have grown up with him as he as reigned for over 60 years. The younger generations love his calls for action and admire how he accepted advances in technology. It is not difficult to understand why. In 2006 when the prime minister was deposed and replaced by the military, it was the King’s diplomacy that made it bloodless and a smooth transition. It is the King who challenges the government on how it spends the people’s money and the work they do in the name of Thailand. It is the King who created and runs a large scale project to support small agricultural communities.

In a developing country, where economics and politics are usually crazy and the majority of people are living in poverty, the King remains the beacon of hope and pillar for what is right. He is the voice of reason and a whistleblower. Unafraid of the consequences he speaks from experience and has the support of the entire country. It certainly becomes difficult to find a similarly popular and righteous person who plays the same kind of role in the States and I unfortunately did not find this type of figure in Nicaragua.

Who comes to mind? Well, in no particular order - Oprah (women’s school in South Africa), Al Gore (global warming), Bill Clinton (Foundation’s HIV work), and then there is Hollywood, such as George Clooney’s public stance on Darfur. However, it is still not comparable because these people are often heavily criticized and none really touches all the areas that the King addresses. Understandably this is a different culture, and I am not saying that I think the US needs a king, but having someone that is so important in the public eye and that person being beloved and seen as the vanguard of the nation is quite a unique experience.

Tuesday, January 8, 2008

Traveling Around BangkokBangkok is a city that is full of hustle and flow. The highways and avenues are full of traffic, there is a smog that settles in and fights the sun’s rays in the morning, and the streets are full of food stands, people, and various types of taxis.

That being said, transportation options are numerous throughout the city. Within the last 10 years the Skytrain (similar to the famous Disney Monorail system) and the Metro subway have greatly eased the flow of traffic and transformed Bangkok into a more modernized city. Combined, both systems cover approximately 40% of the urban city and they are very clean and high tech; for example, commercials and advertisements run on loop on flat screen monitors in Skytrain cars. I spoke with my host about the effects and usefulness of the systems and the answer is two-fold. It is very obvious that people utilize them as business workers of all ages, students, and tourists are ever present, but it lacks in the number of places it touches and in the amount of the city it spans.

The transportation systems are supplemented by the bustling taxi system of Bangkok. A traveler can choose from a regular metered taxi, a metered boat taxi, or spend less and haggle with the notorious tuk-tuks (think open air three wheel motorized carts) and moto-taxis (riding on the back of a motorcycle). Although the tuk-tuks are noisy and give the passenger little to no fresh air, tourists flock to them because they are something out of the norm. I followed suit and can testify to the noise and helter skelter that is the tuk-tuks. However when it comes to open air riding the tuk-tuk is the furthest I will go. Moto-taxis, the cheapest option, could be its own extreme game show on Fox. Drivers zip through any opening in traffic they can find in the busy streets, sometimes lodging themselves in between lanes and buses. I would say if a passenger is carrying while on the moto-taxi they run the risk of losing the carry a long or losing the health.

An interesting development will be if they decide to expand the systems. With so many Thais earning a living working as various types of taxi drivers, one must wonder what kind of effect an increased system would have on the employment rate. It touches upon some of the key aspects of development. At what pace should a developing and modernizing take place? You must keep in mind the general population and if they are able to meet the changes that will come; i.e. finding a new job if there is taken by a computer. Furthermore, a topic that will be touched upon in other posts, what is the happy balance between development and maintaining culture. A topic of great importance in Bangkok, where tradition and religion are steeped deep into every facet of daily life.

Sunday, January 6, 2008

I should begin by saying Merry Christmas and Happy New Year! It has been more than two weeks since my last post and I apologize for the gap. However, I am back on the road conducting what is now the 3rd leg of the project. Since Thailand is very different to anything I am accustomed to I thought it wise to begin with “First Impressions”.

My first contact with something Thai would have to my 16-hour flight from NYC. It sounds much worse than it really is. With a personal TV every passenger has access to hordes of movies, music, and games (ranging from Super Mario Brothers to chess to learning Thai). Everything in the plane is shades of pink and purple to match the important Thai Orchid and service is top-notch. With three above average square meals and sandwiches and fruit by request, it is no wonder why some refer to Thai Airlines as Stuff You Air. Move over British, the Thai know how to fly.

Upon landing it is very evident that Bangkok is a busy International hub. At the immigration check point I waited for 30 minutes because within an hour range of my flight more than 10 other international arrivals had landed (JFK, Boston, London, Taipei, Tokyo, Hong Kong, Etc.). The International feel is continued as my host Mike and I drive through “Downtown Bangkok”. Would you care for gelato at the Italian Ice Cream store? You could stop for drinks at the Heineken roof top bar or eat at any of the authentic Vietnamese, Japanese, Chinese, Thai, Italian, and the list goes on and on for restaurants. For those who need their American Coffee or Slurpees, I counted three Starbucks and two 7-11s on the roughly 2 miles we were on the main avenue.

I would be mistaken not to mention the obvious language barrier. Thai is a remarkably difficult language to grasp. Even when the spelling is written phonetically you are not guaranteed success because the tone is generally flat and certain letters go unpronounced, such as the ‘h’ when preceded by a ‘k’, ‘p’, or ‘t’. After less then 24 hours here, I am nervous to say hello (sa-wa-deekhrup) and thank you (khop-khun-khrup). ‘Khrup’ is the word males add to the end of sentences to show courtesy and proper form and the female equivalent is ‘Kah’. I imagine taking taxis will have to wait until I learn some more of the basics. Luckily Mike lives approximately a mile from the famous Thai Sky Train system. It was built is 1998 andcan take you around the heart of Bangkok in a cost effective and time efficient manner because rumor has it and guides profess it – traffic in Bangkok is bad and driving is even worse.

The last thing I want to mention is the advanced technology that I have seen so far in Thailand. Cell phones here make the States look like the developing country. The Apple iPhone is probably the only US phone that can hold its own in comparison but it is incredibly over priced. Here cell phones work on prepaid systems. You buy any phone and then prepay for the services you use (forget about roll over or unused minutes and contract termination fees). Also, little things make my experience in this developing country much different from the last. For instance a flat screen TV in front of a few street elevators or people with personal handheld screens that carry photos, planners, and everything else you would need were not things I saw while in Nicaragua. Needless to say I was impressed by the technology that is evident and available to Thais in Bangkok.

I will be returning to my pattern of writing at least every 3 days, but judging from the amount of notes I made from just one day I will probably post every other day. Any questions are always welcomed.

Thank You

Thank you for visiting the Blog! Make sure you come back to read about the different cities and non-profits where I will be volunteering. Finally thank you for all the support and donations from family, friends, and mentors at Fairfield University.